Precision functional sphincter-preserving surgery (PPS) for ultralow rectal cancer: a natural orifice specimen extractio
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Precision functional sphincter‑preserving surgery (PPS) for ultralow rectal cancer: a natural orifice specimen extraction (NOSE) surgery technique Cheng‑Le Zhuang1 · Feng‑Min Zhang1 · Zheng Wang1 · Xun Jiang1 · Feng Wang1 · Zhong‑Chen Liu1 Received: 14 May 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background In patients with ultralow rectal cancer, surgical resection of the tumor without impairing sphincter function remains a technical challenge. The purpose of this study was to describe a new technique of transanal natural orifice specimen extraction (NOSE) surgery using our independently developed devices, aiming to achieve precise cancer resection and preserve sphincter function in patients with ultralow rectal cancer. Methods Precision functional sphincter-preserving surgery (PPS) was performed on nineteen patients with ultralow rectal cancer between June 2019 and April 2020. With the help of our independently developed devices, surgeons directly and accurately removed the lower edge of the tumor and retained healthy rectal tissue on the nontumorous side. Hand-sewn anastomosis with a mattress suture was used to achieve sturdy anastomosis. Preoperative baseline characteristics, operative details, 90-day postoperative complications, costs, and anal function score at 6 months after surgery were documented. Results Nineteen ultralow rectal cancer patients with a median distance to the dentate line of 2.0 cm successfully underwent PPS without serious postoperative complications. Six out of nineteen patients (31.6%) received a prophylactic stoma. The average cost was 62164.1 yuan. At 6 months after surgery, the average Wexner anal function score and the average Vaizey score were both 3 points. Conclusions PPS can be employed to precisely resect rectal tumors and preserve sphincter function in ultralow rectal cancer patients. The use of our devices enhanced surgical efficiency, reduced the need for prophylactic stoma, reduced surgeryrelated costs, and prevented abdominal surgical incisions. Keywords Rectal cancer · Sphincter preservation · Natural orifice specimen extraction (NOSE) · Minimally invasive surgery · Hand-sewn anastomosis Colorectal cancer is one of the most common gastrointestinal malignancies, and low and ultralow rectal cancer account for a large proportion of all cases [1, 2]. Approaches to minimize surgical trauma, preserve anal function, avoid permanent stoma, and improve quality of life for patients with low and ultralow rectal cancer have been a longstanding debate in the gastrointestinal field. Laparoscopic low Cheng-Le Zhuang and Feng-Min Zhang contributed equally to this work. * Zhong‑Chen Liu [email protected] 1
Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai 200072, China
anterior resection (LAR) for rectal cancer has been shown to have better postoperative recovery, si
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